Bariatric Surgery Follow Up
See RCGP Top 10 Tips Bariatric Surgery Leaflet
Aims of follow up
1. Dietary assessment and education
2. Identify and treat “medical” complications early e.g. B12 or other vitamin / mineral deficiency
3. Identify and treat any “surgical” complications early e.g. gastric band slippages or internal herniae
4. Support patients to a successful weight loss outcome after bariatric surgery
5. To allow for on-going audit of results
Bariatric surgery follow up, monitoring and supplements
Main roles for primary care is to provide medication reviews for all patients, advise/prescribe supplements (see flowchart), organise blood test monitoring (Gastric Bypass and Sleeve Gastrectomy only) and identify complications requiring referral or admission
Those having Gastric Bypass or Sleeve Gastrectomy surgeries need annual follow-up by primary care. Those having Gastric Band surgery are normally sorted when they get discharged from secondary care at 2yr post-op.
Complications
It is important to look out for acute complications including epigastric or other abdominal pain associated with:
- Dysphagia
- Vomiting
- Reflux unresponsive to PPIs
Most patients with the above acute symptoms would require emergency admission to RCHT.
To ensure a timely referral is made, the British Obesity and Metabolic Surgery Society have produced the Primary care management of post-operative bariatric surgery patients guidance chart (see below). If you are unsure whether a referral is appropriate, particularly regarding weight regain, and the patient is not acutely unwell, the Bariatric Team would welcome Advice & Guidance Referrals in the first instance.
Non NHS funded patients who have had bariatric surgery (private patient)
We are sometimes asked to take on the care of patients who have had bariatric surgery elsewhere, often as Private patients. We are not able to take on their care as we have neither the capacity nor the funding. We strongly encourage all such patients to attend regular follow up with their original surgical team. If there is an emergency situation we will of course treat the patient to get them through the emergency phase of their care, but any subsequent treatment will need to be done by the original care provider.
Resources
British Obesity & Metabolic Surgery Society: https://bomss.org
Review Date November 2021
Next Review Date November 2022
GP Sifter Dr Laura Vines
Contributor Mr Jeremy Gilbert